What are community expectations on ambulance services when a pandemic strikes? When all the business and recreational activities are suspended, do paramedics have the professional obligation to work? A study of the New Edith Cowan University in Australia.

On 15 July 2020, Cameron Anderson, MD and Ambulance Emergency Responder in Australia, with other colleagues issued research with the New Edith Cowan University in Australia on the professional obligation of paramedics during a pandemic like COVID-19.

 

Ambulance service during a pandemic: What paramedics can or are not forced to do?

COVID-19 (SARS-CoV-2) strongly managed to make us understand personal protection and social distancing. However, many professional figures in the world could not respect these precautions. By April 2020, hundreds of health-care workers around the world had died [7]. A problem that many EMS systems worldwide had to face was the lack of personal protective equipment (PPEs) and medical supplies.

The question that many asked was between whether or not to provide care or protect themselves. This is an ethical dilemma and is fundamentally challenging assumptions about professional obligation and personal risk. When happens if the right to protect oneself from serious risk outweighs the obligation to respond to patients in need? There is no way to establish when a personal risk becomes an acceptable part of a professional obligation to respond. [8]

According to the researchers, the professional obligation for paramedics on ambulance largely depend on their own risk assessment, perception of risk, and personal value systems. The study revealed that 86% of interviewed paramedics stated that professional obligation should not be considered an unlimited and
absolute expectation. [9]

 

Paramedics and ambulance service during a pandemic: What does the community expect? – Methods of research

However, what does the community think about the ambulance service during a pandemic? There still is no evidence establishing these expectations specifically in the context of pandemic response. The research we are reporting in this article will provide a unique insight into how the community viewed the professional obligations of paramedics before a pandemic occurs. The following research was conducted in the months leading up to the COVID-19 coronavirus pandemic.

They recruited focus groups of Australian community members aged 18 years or over. Anyone currently employed as a paramedic was excluded, although other health-care professionals were not. The research team developed a central set of questions and probes. To analyze the data, a coding protocol was developed using a
combination of several qualitative analytic approaches.

 

The issue of accessing PPEs for paramedics during a pandemic

One of the interviewed community members declared that if paramedics have PPE, then yes, I expect them to be responding in a pandemic with the ambulance, but if not, it’s hard to say. The matter is: community still need them to be at service of the population. However, not if it means they are at high risk of getting sick themselves.

Access to PPE has certainly been an issue globally during the COVID-19 coronavirus pandemic. [14,15] According to the research results, if PPE is provided, then the response is expected. If PPE is lacking, then it comes back to questions around acceptable levels of risk and what that threshold will be for individual paramedics.

A survey of 245 Australian doctors in April 2020 demonstrated that 61% felt pressure from other staff not to wear a mask and more than half felt guilt or shame for wearing one. A further 86% reported feeling anxious about the level of PPE provided to them during the pandemic, and 83% did not trust that the Australian guidelines were adequate.

A worrying data that came out from the survey is that many doctors declared of being threatened and warned against wearing PPE by their employers. [16] It is likely that paramedics on the frontlines will hold similar
concerns as well. And these concerns, it appears, are valid according to many of the community participants in this research.

Another community member who participated in the survey considered the responsibility of the ambulance services to the paramedics themselves. It is very unbelievable to send them in if the association can’t protect them. There also are participants who did non expect paramedics during a pandemic.

In conclusion, a high percentage of community members allegedly do not want to get paramedics sick, however, they need ambulance services in case of emergency.

In order to read the complete detailed analysis of this research, please find the complete file link at the end of the article.

 

In conclusion: what does this research on community expectations of paramedics during a pandemic take to?

The answer is an important and unique insight. The findings support previous research that highlights a lack of clarity regarding the concept of professional obligation, specifically, where does it begin and end?

It is, otherwise, clear that it must be addressed as a matter of urgency through the development of clear guidelines outlining obligation to respond under both normal day-to-day operations and during crisis situations, like during a pandemic.

Another topic that this research highlighted is a strong belief that paramedics are entitled to a work environment free from the threat of physical harm and that paramedics may refuse to enter an incident scene they deem unsafe. However, this belief is challenged when the risk of infectious disease is introduced.

The expectations of the participants are that an ambulance would be available to them when and where
required, and that the ambulance service would take care of any safety implications arising from the infectious disease risk. We remind that this survey has been made in the very first months of COVID-19 coronavirus pandemic, before the very high peaks of the virus contagion, so people surely were having a different idea than now. It will be important to see how these expectations evolve now that the participants will have real-world lived
experience of a pandemic.

 

AUTHORS

Cameron Anderson, MDis&EmergResp: School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

Julie Ann Pooley, PhD: and School of Arts and Humanities, Edith Cowan University, Joondalup, WA, Australia

Brennen Mills, PhD: School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

Emma Anderson, LLB: School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

Erin C. Smith, PhD, MPH, MClinEpi: School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

 

REFERENCES

1. World Health Organization. SARS (Severe Acute Respiratory Syndrome). https://www.who.int/ith/diseases/sars/en/. Accessed April 15, 2020.
2. World Health Organization (WHO). Consensus Document on the Epidemiology of Severe Acute Respiratory Syndrome (SARS). Geneva: WHO; 2003.
3. World Health Organization (WHO). Director-General’s opening remarks at the media briefing on COVID-19-11 March 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarksat-the-media-briefing-on-covid-19—11-march-2020. Accessed April 15, 2020.
4. Johns Hopkins University. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). https://coronavirus.jhu.edu/map.html. Accessed April 15, 2020.
5. Editorial. COVID-19: protecting health-care workers. Lancet. 2020; 395(10228):922. doi: 10.1016/S0140-6736(20)30644-9
6. Characteristics of Health Care Personnel with COVID-19 — United States, February 12–April 9, 2020. MMWR Morb Mortal Wkly Rep.2020;69(15):477–481. doi: 10.15585/mmwr.mm6915e6
7. Medscape. In Memoriam: healthcare workers who have died of COVID-19. April 01, 2020. https://www.medscape.com/viewarticle/927976. Accessed April 15, 2020.
8. Iverson KV, Helne CE, Larkin GL, et al. Fight or flight: the ethics of emergency physician disaster response. Ann Emerg Med. 2008;51:345–353.
9. Smith E, Burkle FM Jr, Gebbie K, et al. A qualitative study of paramedic duty to treat during disaster response. Disaster Med Public Health Prep.2019;13(2):191–196. doi: 10.1017/dmp.2018.15
10. Smith E, Burkle FM Jr, Gebbie K, et al. Acceptable limitations on paramedic duty to treat during disaster: a qualitative exploration. Prehosp Disaster Med. July 2018;33(5):466–470 doi: 10.1017/S1049023X18000857
11. Patton M. Two decades of developments in qualitative inquiry: a personal, experiental perspective. Qual Soc Work. 2002;261–283.
12. Institute of Medicine (US) Forum on Medical and Public Health Preparedness for Catastrophic Events. Crisis Standards of Care: Summary of a Workshop Series. Washington, DC: National Academies Press; 2010. B, Summary of guidance for establishing crisis standards of care for use in disaster situations: a letter report. https://www.ncbi.nlm.nih.gov/books/NBK32748/. Accessed April 15, 2020.
13. Gebbie K, Peterson PA, Subbarao I, White KM. Adapting standards of care under extreme conditions. Disaster Med Public Health Prep. 2009; 3(2):111–116. doi: 10.1097/DMP.0b013e31819b95dc
14. Robertson J. Health workers running out of coronavirus masks, protective gear as doctors call for urgent action. https://www.abc.net.au/news/2020-03-25/coronavirus-queensland-ppe-mask-shortage-doctors/12086562.
    Accessed April 15, 2020.
15. Dow A, Cunningham C. In ‘$2 raincoats’ on virus front line, medics call for action on PPE. https://www.theage.com.au/national/forced-to-wear2-raincoats-nurses-doctors-demand-action-on-ppe-20200408-p54i8q.html?fbclid=IwAR2hp403WXJAjUy8T7sh0-Aot2gLS5_toMRpxLB4QdA2I9hNBB-F27-qpEQ. Accessed on April 15, 2020.
16. Wylie B, Timms P, Scott S. Coronavirus treatment doctors report trauma, threats over lack of PPE in hospitals. https://www.abc.net.au/news/2020-04-09/coronavirus-doctors-trauma-as-ppe-equipment-sharing-re-use/
    12136692. Accessed April 15, 2020.
17. Harris, SA, Nicolai, LA. Occupational exposures in emergency medical service providers and knowledge of and compliance with universal precautions. Am J Infect Control. 2010;38(2):86–94.
18. Thomas B, O’Meara P, Spelten E. (2017). Everyday dangers – the impact infectious disease has on the health of paramedics: a scoping review. Prehosp Disaster Med. 2017;32(2):217–223. doi:10.1017/S1049023X1600149716

 

 

READ ALSO

Population Vs Paramedics: Indonesians Against Pandemic Victims Protocol Of Ambulance Transportation

Does Uganda Have An EMS? A Study Discusses The Ambulance Equipment And Professionals Lack 

Can Rural Doctors And Paramedics Respond To Complex Health Needs?

Paramedics And Healthcare Workers In Mexico Must Be Treated With Respect, Especially During A Pandemic

500 EMTs And Paramedics Leading To NY To Join The Fight Against COVID-19 Pandemic

 

SOURCES

Do Paramedics Have a Professional Obligation to Work During a Pandemic? A Qualitative Exploration of Community Member Expectations

ECU official release

Australian Government: Department of Health: Coronavirus